| NPI | 1104002302 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE BARDLE Medical Secretary 314-878-7630 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: MO R6J45) |
| Enumeration Date | 2008-01-17 |
| Last Update Date | 2008-01-17 |